Susan Sontag’s Illness as Metaphor: Decoding Discussions on Disease
In this 1977 text, Susan Sontag traces the ways in which illnesses have been used as metaphors throughout the course of human history, exploring the mystery, stigma, and even romanticism surrounding them. She focuses particularly on tuberculosis (TB) and cancer, which have been metaphorized in similar yet contrasting ways. By explaining the mythology surrounding illnesses like TB and cancer, Sontag hoped to demystify them and strip them of their stigma.
According to Sontag, TB and cancer have been especially ripe for metaphor—TB in its heyday and cancer in the present day—because both were/are poorly understood and terribly feared. Fatal and its etiology unknown, TB was thought of as cancer is now as both “intractable and capricious.” Seen as “an insidious, implacable theft of a life,” their very names became taboo. It was common to conceal the diagnosis of TB from patients in the 19th century. Even in 1970’s Italy and France it was “the rule for doctors to communicate a cancer diagnosis to a patient’s family but not to the patient.” It was believed that even hearing the name of the illness would accelerate the progress of the disease.
Fear and taboo are where the most apparent commonalities between TB and cancer metaphors appear to end. TB was thought to “produce spells of euphoria, increased appetite, [and] exacerbated sexual desire” while cancer was “thought to cripple vitality, make eating an ordeal, deaden desire.” As a result, the popular mythology characterized TB as a disease that “speeds up life, highlights it, [and] spiritualizes it” while cancer was seen as one that deadened before it killed. The former was believed to yield “relatively painless… enobling, placid… deaths” and the latter “ignoble, agonizing… deaths.”
These contrasts derive from the popular mythology surrounding the causes of TB and cancer. The former was believed to be caused by an excess of passion, while cancer was thought to be the result of insufficient or repressed passion. In the romantic period, when intense feeling and passion were celebrated, TB was very much romanticized. It was considered a sign of “being genteel, delicate, [and] sensitive” as well as “a mark of distinction and breeding.” The “tubercular look”—with its characteristic thinness and pallor—soon became the aristocratic ideal in the 1880’s. While the idea of TB as a disease of passion lent itself frequently to images of fallen, yet “interesting” libertines, it was also applied to people seen as having sublimated, spiritualized passions. TB was seen as a “moral” or moralizing disease, providing “a redemptive death for the fallen” as it does for Fantine in Les Miserables, or simply a chance for the already virtuous to “boost themselves to new moral heights” as it does with Little Eva in Uncle Tom’s Cabin who “during her last days urges her father to become a serious Christian and free his slaves.”
Despite the positive tropes surrounding the TB “character type,” Sontag argues that the existence of a disease character type to being with is intrinsically punitive in its moralism. The “romantic idea that diseases expresses the character” of a person is not so romantic when it is “invariably extended to assert that character causes the disease” and that disease is thus the fault of the patient; its cure his responsibility. The cancer metaphor is especially harsh, however, because it implies not only a character type that causes cancer but a criticism of said character. As a disease of repressed or unexpressed passion, cancer is portrayed as a “failure of expressiveness,” a metaphor that evokes as much disdain as pity. As the doctor in W.H. Auden’s poem “Miss Gee,” puts it:
‘Cancer’s a funny thing.
‘Nobody knows what the cause is,
Though some pretend they do;
It’s like some hidden assassin
Waiting to strike at you.
‘Childless women get it.
And men when they retire;
It’s as if there had to be some outlet
For their foiled creative fire.’
This mystification of cancer as the result of some “foiled creative fire” paints the cancer victim as, to put it bluntly as Sontag does, “one of life’s losers.”
Interestingly, in being psychologized as diseases of improper energy and passion, both TB and cancer became metaphors for unwise economic behavior, a malaise not only individual but societal. Associated with excessive energy and passions, TB, also referred to, revealingly, as “consumption,” went against all the dictates of early capitalism: “ regulated spending, saving, accounting, discipline—the rational limitation of desire.” Cancer, on the other hand, with its repression of energy, contradicts the ideals of modern capitalism: growth and expansion. Although both illnesses can be discussed in economic terms, cancer differs from “consumption” in that its descriptions are dominated by the language of warfare rather than economics. Cancer cells are “invasive” and to be “bombarded” with radiotherapy or attacked through the “chemical warfare” of chemotherapy. Such language dehumanizes the cancer victim, making their body a battlefield and their ailment an enemy to be fought with any means. This “total warfare” mindset towards treating cancer has led to particularly harsh treatments; it is accepted as commonplace that the treatment often feels “worse than the disease.”
Whether as economic malaise or wartime enemy, TB and cancer have been politicized as metaphors for society’s gravest ills. Politicizing disease made illness metaphors even more problematic as it led to a shift to view “of the disease not as a punishment but as a sign of evil, something to be punished.” Cancer, in particular, has come to be politicized to describe a situation seen as “unqualifiedly and unredeemably wicked.” Modern totalitarian movements have used the cancer metaphor frequently as “an incitement to violence” against the groups they singled out and scapegoated as evil. Indeed, the cancer metaphor is “implicitly genocidal” because it implies the necessity of extreme measures of eradication; as “the Jewish problem” the Nazis spoke of, “to treat a cancer, one must cut out much of the healthy tissue around it.” Even in modern day America, we speak of the “war” against cancer and both fear and denounce it as one of the ultimate enemies not only to individuals but to society.
However against them she is, Sontag, of course, understands how these vilifying metaphors came to be. She recognizes the challenge of being “morally severe” in the 21st century “when we have a sense of evil but no longer the religious or philosophical language to talk intelligently of evil.” Her aim at unravelling disease metaphors, however, was a noble one; by striving to eradicate these metaphors, she fought against the enormous stigma surrounding people with illnesses like cancer, people who need our support—not fear, contempt, or prejudice. She went on to explore more contemporary usages of disease metaphors in her sequel AIDS and Its Metaphors. While Sontag covered great ground with her discussion of physical illness, the curiosity remains surrounding what she thought of the stigmas of mental illness—especially when she saw the “psychologizing” of physical disease as so problematic.
Susan Sontag wrote four novels, The Benefactor, Death Kit, The Volcano Lover, and In America, which won the 2000 National Book Award for fiction; a collection of stories, I, etcetera; several plays, including Alice in Bed; and eight books of essays, among them Against Interpretation and On Photography, which won the National Book Critics Circle Award for criticism. In 1978, while she was battling cancer, Sontag wrote Illness as Metaphor. Almost a decade later she wrote its sequel, AIDS and Its Metaphors, which extended her arguments about TB and cancer in the former book to the contemporary AIDS pandemic. Her books have been translated into thirty-two languages. In 2001, she was awarded the Jerusalem Prize for her body of work. She died in New York City in 2004.